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Medicare Hospice Benefit

Topic Overview

Medicare is a health insurance program for people 65 years of age and
older, for some people younger than 65 who have disabilities, and for people
with long-term (chronic) kidney failure treated with dialysis or a transplant.
Medicare is administered by the Centers for Medicare and Medicaid Services
(CMS) of the United States government.

The Medicare hospice benefit is described in Part A, which talks about hospital insurance. Part A benefits
provide coverage for hospitals, nursing facilities (but not custodial or long-term care), some home health care, and
hospice. People (including a spouse) who paid Medicare taxes while they were
working are eligible for Part A benefits. A monthly payment, or premium, is not
required for Part A benefits.

Eligibility

The Medicare hospice benefit provides coverage for services related
to a life-limiting illness. Hospice care is covered under Medicare Part A
benefits. You must meet all of the following criteria to be eligible for the
Medicare hospice benefit:

You must be eligible for Medicare Part A
benefits.

Your doctor and hospice medical director must certify that you have a life-limiting illness and are likely to live 6 months or less if your illness follows a normal course.

You must sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your life-limiting illness. (Medicare will still cover
services for any health problem that is not related to your life-limiting
illness.)

You must receive care from a hospice approved by
Medicare.

Covered services

Medicare pays the hospice program a daily (per diem) rate that is
intended to fully cover most services related to a
life-limiting illness, including:

Hospice nursing care in your home. This
includes intermittent visits by a nurse to check on your symptoms. Nurses are
also available 24 hours a day, 7 days a week to visit if you need help.
Live-in nursing care is not covered.

Medical supplies and
equipment, such as a wheelchair, hospital bed, or incontinence
pads.

Medicines for symptom control and pain relief. You will
have to pay no more than $5 for each prescription drug and other related
products.

Visits to your doctor to help manage your life-limiting
illness.

Intermittent homemaker and home health aide services.
The service of a live-in homemaker or home health aide is not
covered.

Physical, occupational, or speech therapy, if needed
because of your life-limiting illness.

Dietary
counseling.

Visits from a counselor or social
worker.

Spiritual care, if desired.

Visits from trained
volunteers. Volunteers are available on a short-term basis to provide
companionship, to help with your care, or to run
errands.

Short-term respite care so your caregiver can rest or take some time off (you may need to pay a small copayment).

Temporary hospitalization, if needed, to help manage symptoms
that cannot be controlled at home.

If your condition changes so that hospice is no longer appropriate,
you can get your previous Medicare benefits reinstated. You can also re-apply
for hospice benefits at a later time if needed.

For more information

The Centers for Medicare and Medicaid Services (CMS) of the United
States government manages the Medicare hospice benefit. You may call toll-free
(1-800-633-4227) or visit its Web site at www.cms.gov
for more information.

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